Content by Keyword: Homelessness Issues

This paper describes the specific ways in which Medicaid reimbursement is being used for some of the services provided to chronically homeless people, including services that address their health and behavioral health needs and help vulnerable people get and keep stable housing. States have used different types of Medicaid benefits and payment mec

The chronically homeless people on whom this study focuses have multiple, complex, and interacting physical and behavioral health conditions. Achieving the best results for these clients and the public institutions and systems from which they get care requires effective engagement, service delivery, and care coordination. To understand how this ca

In 2014, most homeless people will become Medicaid-eligible under the Affordable Care Act (ACA) of 2010 based on their low incomes. Many homeless people have complex physical and behavioral health conditions for which they seek care through frequent use of emergency rooms and inpatient hospitalization, at considerable cost in public resources.

This Issue Paper describes the ways that Medicaid is being used now and might be used in the future under provisions of the Affordable Care Act of 2010 to serve chronically homeless people. [67 PDF pages]

Several federal agencies also offer sources of funding that may be used to directly provide SE to individuals with mental illness or otherwise encourage them to work. These include various block grants, VR and special education programs, VA services, and other demonstrations.
1. SAMHSA's Community Mental Health Services Block Grant

PSH is a phenomenon of the 1990s and 2000s, when homelessness assistance systems evolved and their goals shifted and changed. PSH beds available to end people's homelessness went from about zero in the late 1980s to estimates of 114,000 beds in fall 1996 (Burt et al. 1999), about 188,000 beds in January 2007, and 284,298 beds in January 2013 (H

If the promise of new and emerging approaches to integrated and cost-effective care for people experiencing chronic homelessness and PSH tenants is to be realized, many aspects of Medicaid state plans will have to be brought into alignment. Service definitions will need to be updated, examining them to assure that they can accommodate the evidence

Three of our case study sites--Hennepin Health in Minnesota, Housing for Health in Los Angeles, and Together4Health in Chicago--were mounting innovative approaches for the integrated and coordinated care that evidence shows has promise for people with complex needs and histories of chronic homelessness. All link Medicaid-funded services with housi

Chapters of this report have described many strategies being used in our case study sites to expand and integrate health and behavioral health care under Medicaid for our target population, and often for far larger groups such as all poor people (coverage expansion waivers, Accountable Care Organization), or all people with complex interacting dis

Agencies involved in providing PSH may offer only the housing part of the package, only the services part, or both. The most common configuration is some amount of partnering, as even the providers with the most integrated and comprehensive approaches to delivering housing and services will still develop relationships with other agencies offering

This research has sought to identify the many ways that our case study states and communities are moving forward, using and modifying their Medicaid programs and health care delivery systems to better serve people with histories of chronic homelessness. Our findings indicate that Medicaid's configurations up through 2013 offered opportunities for

The past few years have been a time of great ferment in the health care world, with the next few years promising to see even more evolution and change. Medicaid is an important part of these changes, as states design and implement the coverage expansion aspects of the Affordable Care Act while also looking for ways to get better results from the h

This chapter has highlighted some of the challenges in providing integrated housing and services for people with histories of chronic homelessness as well as some of the opportunities to use innovative strategies to meet their needs. The next chapter includes a summary of some of the emerging practices this research has followed that show promise

While many of the financing and service delivery approaches described in this report have significant implications for the services available to people experiencing chronic homelessness and PSH tenants, including services that are delivered in PSH settings, for the most part the Medicaid benefits we have described were not specifically designed to

The Affordable Care Act created a new optional Medicaid benefit that states may use to create "health homes" for people with chronic conditions, including mental health conditions, substance use disorders, and chronic physical conditions. 108 States may develop more than one health home benefit program for different target groups of beneficiar

Service providers working with PSH tenants and people experiencing chronic homelessness reported that a relatively small but growing number of the people they serve are eligible for both Medicare and Medicaid. These "dual eligible" individuals are among the costliest patients enrolled in both Medicare and Medicaid, and they often receive very frag

In states that have expanded Medicaid eligibility under the provisions of the Affordable Care Act, a significant number of adults who are eligible because their incomes are low enough to qualify (up to 133 percent of the federal poverty level) are likely to have substance use disorders. The Affordable Care Act includes services for substance use d

In several of the communities included in this study, health care providers and other stakeholders have been thinking about the workforce implications of the expansion of eligibility for Medicaid, coupled with potential changes in payment mechanisms as states increasingly move toward managed care arrangements for financing health care. Many commun

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